IJIMS.2016.131

Type of Article: Original Research

Volume 3; Issue 6: June 2016

Page No.: 321-326

DOI: 10.16965/ijims.2016.131

Comparison of  Tramadol and Dexamethasone as an adjuvant to Bupivacaine in Supraclavicular brachial plexus block: A Randomised Comparative Study In Patients undergoing Elective Upper limb surgeries

Sudha shah *1, Bharat Shah 2, Chameli Deb 3.

*1 Professor, Department of Anesthesia, Parul Institute of Medical Sciences and Research, Vadodara, Gujarat, India

2 Dean/Professsor, Department of Anesthesia, B.J  Medical College, Ahmedabad, Gujarat, India.

3 Ex. Assistant Professor, Department of anesthesia, B.J  medical college, Ahmedabad, Gujarat, India.

CORRESPONDING AUTHOR ADDRESS: Dr. Sudha shah Professor, Department of Anesthesia, Parul Institute of Medical Sciences and Research, Vadodara, Gujarat, India. E-Mail: sudhashah11111@gmail.com

ABSTRACT

Background: Supraclavicular nerve block is a good alternative to general anesthesia for upper limb surgery. This avoids the untoward effects of general anesthetic drugs and upper airway instrumentation. It achieves complete muscle relaxation, intraoperative hemodynamic stability, and postoperative analgesia.

Objectives: To compare the postoperative analgesia following supraclavicular brachial plexus block with Tramadol or Dexamethasone as an adjuvant  to bupivacaine in elective upper extremity surgery.

Materials and Methods: Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block with Bupivacaine were randomly divided in to two groups;  group A  received Tramadol (2mg/kg) and  group B  received Dexamethasone (0.15mg/kg) as an adjuvant  to Bupivacaine. The duration of postoperative analgesia was recorded in both groups using pain VAS score which was determined by maximum VAS score of 8-10 and when patient demands for additional analgesia.

Results: The mean duration of postoperative analgesia in the Dexamethasone group was 1023.87 -+161.01  minutes while in the tramadol group it was 454.47+-44.29 minutes.

Conclusion: Dexamethasone with local anaesthetic prolongs postoperative analgesia significantly longer than Tramadol (P<0.05) when used as admixture to local anaesthetic in brachial plexus block in upper extremity surgery.

Key Words: Dexamethasone, Tramadol, Bupivacaine.

REFERENCES

  1. Bazin JE, Massoni C, Bruelle P, Fenies V, Groslier D, Schoeffler P. The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine, and sufentanil. Anaesthesia 1997;52:858-62.
  2. Antonucci S. Adjuvants in the axillary brachial plexus block Comparison between clonidine, sufentanil and tramadol. MinervaAnestesiol 2001;67:23-7.
  3. Ali Movafegh, MD, Mehran Razazian, MD, Fatemeh Hajimaohamadi, MD and Alipasha Meysamie Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade. Anesth Analg 2006;102:263-7
  4. Chattopadhyay S, Mitra L G. Tramadol as an adjunct  for Brachial plexus block. J Anaesth Clin Pharmacol 2007;23(2):187-9.
  5. Colombo G ,Padera R ,Langer R , Kohane D S Prolonged duration of local anaesthetic with LPSP containing bupivacaine and dexamethasone. 2005;1;75(2):458-64.
  6. Johanson A, Hao J. Local corticosteroid application blocks transmission in normal nociceptive c-fibres. Acta Anesthesiologica scand 1990;34:335-8.
  7. Dan J. Kopacz, MD, Peter G. Lacouture, PhD, Danlin Wu, PhD, Partha Nandy, PhD, Ruth Swanton, MPH and Craig Landau, MD. The Dose Response and Effects of Dexamethasone on Bupivacaine Microcapsules for Intercostal Blockade (T9 to T11) in Healthy Volunteers. A&A Feb 2003;96(2):576-582.
  8. Estebe JP, Le Corre P, Clement R, Du Plessis L, Chevanne F, Le Verge R, Ecoffey C. Effect of dexamethasone on motor brachial plexus block with bupivacaine and with bupivacaine-loaded microspheres in a sheep model. European journal of Anaesthesiology. 2003 Apr 1;20(04):305-10.
  9. Kapral S, Gollmann  G,  Walti B, Likar R, Sladen RN, Lehofer    Tramadol added to mepivacaine prolongs the duration of an axillary brachial plexus blockade. Anaesthes Analg  1999;88:853-6.
  10. Kayser V, Besson JM, Guilbaud G. Evidence for noradrenergic component in the antinociceptive effect of the analgesic agent tramadol in an animal model of clinical pain. Eur J Pharmacol 1992; 224: 83–8
  11. C. Cummings III, D. E. Napierkowski, Parra-Sanchez, A. Kurz, J. E. Dalton, J. J. Brems and D. I. Sessler Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. BJA 2011;107(3):446-453.
  12. Sherstha B R, Maharajan S K, Tabedar S, Supraclavicular block with or without dexamethasone. KUMJ 2003;1:94-95.
  13. Winnie AP, Tay C-H, Patel KP, Ramamurthy S, Durrani Z. Pharmacokinetics of local anaesthetics during brachial plexus blocks. Anaesth analg 1977;56:852-61.
  14. Robaux S, Blunt C, Viel E, et al. Tramadol added to 1.5% Mepivaciane for axillary brachial plexus block improves postoperative analgesia . Anaesth Analg 2004 April;98(4):1172-7.
  15. Lund PC, Cwik JC, Vallesteros F. Bupivacaine – a new long acting local anaesthetic agent. A preliminary clinical and laboratory report. Anaesth Analg 1976;49:103-13.
  16. Castillo Jenny, Curley J, Hotz J, et al. Glucocorticoids prolong rat sciatic nerve blockade in vivo from bupivacaine microspheres. Anaesthesiology 1996;85:1157-66.
  17. Stan T, Goodman E, Cardida B, Curtis RH. Adding methylprednisolone to local anaesthetic increases the duration of axillary brachial plexus block. Reg Anaesth Pain Med 2004;29:380-1.
  18. Shrestha BR et al comparative study between tramadol and dexamethasone as an admixture to bupivacaine . JNMA 2007;46(4):168.
  19. de Jong RH, Wagman IH. Physiological mechanism of peripheral nerve block by local anaesthetics. Anaesthesiology 1963;24:684-7.
  20. Partridge BL, Katz J, Bernirschke K. Functional Anatomy of brachial plexus sheath. Implications for Anaesthesia. Anaesthesiology 1987;66:743-7.
  21. Vieira P A et al .Dexamethasone with bupivacaine increases duration of analgesia in USG guided interscalene brachial plexus blockade. Eur J Anaesthesiol.2010 Mar, 27(3):285-8.
  22. Mannion et al. Tramadol as adjunct to psoas compartment block with levobupivacaine . BJA. 2005;94(3):352-6.
  23. Olfa kaabachi et al. Tramadol as an adjuvant to lidocaine for axillary brachial plexus block . Anesth. A nalog. 2009 Jan;108(1):367-70.

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